Cardio disease

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What percentage of deaths are CD responsible for

38%
What are the 5 classifications of CD
- Heart murmurs
- Arrythmias
- Valvular heart disease
- Coronary heart disease
- Stroke
What are some risk factors associated with CD
- Family HX
- Increasing age
- Type I Diabetes
- High cholesterol
- Obesity
- Tobacco use 4x's @ 2packs/day
What is a sinus rhythm

Normal heart sounds
What are the two types of murmurs
- Functional (Innocent)
- Pathological (Organic)
Define functional murmur
- Bloof flowing throught the heart has increased turbulence
- No pathology
Patholigic (Organic) murmur
- Can be congenital or acquired
- Result of cardiac valvular disease or problems in electrical conduction
Pathologic murmurs associated with valvular disease may require what

Antibiotics prior to dental procedures
What are some examples of congenital murmurs
- Osteogenesis imperfecta
- Elhers-Danios Syndrome
- Marfan syndrome
What are some examples of acquired murmurs
- Rheumatic heart disease
- Syphillis
- Degenerative valvular disease
What are 4 examples of degenerative valvular disorder
- Senile calcific aortic stenosis
- Mitral valve prolapse
- Drug induced
- Radiation
What is rheumatic heart disease caused by

A streptococcal pharyngitis which causes an autoimmune reaction that can damage the heart valves (mitral)
What is senile aortic stenosis

As some people age the aortic valve may undergo a calcification process
What is an arrythmia

A disturbance of the normal cardiac rhythm, rate or conduction through the cardiac tissues
What is tachycardia
- Abnormally rapid heart rate
- Over 100 beats/minute
What is bradycardia
- A slow heart rate
- Less then 60 beats/minute
What condition can cause low Bp

Anemia
What is the SA node

a small mass of tissue with characteristics of both muscle and nerve tissue
Where is the SA node located

In the right atrium
What does the SA node do

It regulates the contraction of the atria's prior to the contraction of the ventricles
What are the 3 types of Bradycardias
- Sinus bradycardia
- Sinoarterial heart block
- Atrioventricular heart block
What are the 5 types of Tachycardias
- Sinus tachycardia
- Atrial tachycardia
- Atrial flutter
- Atrial fibrilation
- Ventricular tachycardia
What are the 2 types of cardiac arrest
- Ventricular fibrillation
- Ventricular asytole
What are the 6 etiologies of cardiac arrhythmias
- Carediovascular disease
- Pulmonary disorder (Pneumonia, COPD)
- Autoimmune disorder (Lupus)
- Systemic disease (Thyroid disease)
- Drugs with adverse side effects (caocaine)
- Electrolyte imbalance (Potassium:Bulimia)
What are the clinical manifestation of tachycardia
- Palpatation
- Chest pain
- Syncope
What are the clinical manifestations of bradycardia
- Fatigue
- Dizziness
- Syncope
What is the most common kind of cardiac arrythmia

Atrial fibrillation
What is atrial fibrillation
- A common arrythmia characterized by a very high and rapid rate of 400-650 beats/minute
- The most common cause of stroke in patients over 70
What is the chemistry behind atrial fibrillation
- electrical impulses are replaced by disorganized electrical impulses leading to irregular conduction to the ventricles
- Cause decrease in cardiac output
What are some clinical symptoms of A fib
- Shortness of breath upon exertion
- Dizziness
- Syncope
- Fatigue
Who is cardiac ablation surgery mostly done on

Children
Why do we want cardiac patients on a pre porcedural rinse

To reduce bacteremia
What is considered a short dental appointment

30-45 minutes
When are appointments scheduled

Late AM
What is the recommendation for use of local anesthetics with vasoconstrictors

2 carpules of 1/100,000 lidocaine w/epi
What are the 3 etioliges of valvular heart disease
- Rheumatic fever
- Congenital abnormalites
- Bacterial endocarditis
What is stenosis

an incomplete opening of the heart valve
What is regurgitation

an incomplete closure which causes a back flow of blood through the valve
what is the most common heart valve abnormality

mitral valve prolapse
How is mitral valve prolapse confirmed

with an echocardiogram
what two medication are given to patients with MVP

Beta blockers & CCB
What % of ppl with rheumatic fever develop rheumatic heart disease

3%
What is coronary heart disease

a group of diseases which affect the heart tissue due to a decreased or inadequate blood supply
What is arteriosclerosis

a thickening n loss of elasticity of the walls of the coronary arteries
What is atherosclerosis

Plaque formation
What etiology of coronary heart disease has a oral systemic condition

atherosclerosis
What are the 6 etiologies of coronary heart disease
- arteriosclerosis
- atherosclerosis
- Congential abnormalities
- Infection
- Autoimmune disease:Lupus
- Coronary embolism:blood clot
What are the 3 types of coronary heart disease
- Angina pectoris
- Myocardial infarction
- Congestive heart failure
What is the #1 antianginal drug

Long acting nitrates (vasodilator)
What 4 factors may precipitate an anginal attack
- Physical activity
- Emotional stress
- Large meals (parasympathetic response)
- Extreme temperature changes
What are some clinical symptoms of an anginal attack
- Burning squeezing or crushing tightness in the chest
- Pain radiates from the heart to shoulder and down left arm
What is the onset and duration of Amyl Nitrate
- 0.5 minutes
- 3-5 minutes
What is the onset and duration of sublingual nitroglycerin
- 1-3 minutes
- 30-60 minutes
What is the onset and duration of translingual nitroglycerin
- 2 minutes
- 30-60 minutes
What is the onset and duration of transmucosal nitroglycerin
- 1-2 minutes
- 180-300 minutes
What is the onset and duration of sublingual isosorbide dinitrite
- 2-5 minutes
- 60-180 minutes
What is the onset and duration of sublingual/chewable erythrityl tetranitrate
- 5 minutes
- 180 minutes
What is the recommended appointment time for an angina patient
- Late AM
- Early PM
For stable angina patients taking beta blockers what vasoconstrictor can be used

Levonordefrin
If inhalant 0.3 ml amyl nitrate is effective how soon should it start working

20-30 seconds
Vitals should be taken _____ on mycordial infarction patients

before and after
How long do we wait to call EMS if a patient has a previous history of angina

15-20 minutes
What are some signs of a MI
- Pain which is intense
- Anxiety
- Irritability
- Nausea
- Sweating
What are the drug catergories prescribed to patients that have had a MI
- Antiplatelet
- Anticoagulant
- Antihypertensive/Diuretic
- Beta-Adrenergic blocker
- Statins
For patients taking Statins, CCB and Anti-coagulants what 3 antifungal medication should be avoided
- Itraconazole
- Ketoconazole
- Miconazole
What statin can be used with cardiac patients

Nystatin
For patients taking Statin and anti-coagulants what 3 antibiotics shouls be avoided
- Erythromycin
- Claithromycin
- Azithromycin (Zithromax)
To avoid using epi impregnated cords during crown and bride procedures what are the two alternatives
- Visine
- Afrin
If a MI patient does not respond to nitrolycerin what can we given

325mg of aspirin
What % of nitrous oxide can be administered
- 35% nitrous
- 65% oxygen
What side of the heart is failing with peripheral edema

Right side
What are the 4 categories of drugs of the managment of CHF
- Diuretic
- Nitrate
- CCB
- Cardiac glycoside (Digoxin)
What is the most common drug prescribed for the treatment of CHF

Digitalis
What antibiotics should be avoided with CHF patients taking digoxin
- Erythromycin
- tetracycline
What are the three common oral effects of Cardiovascular drugs
- Xerosotomia
- Gingival overgrowth
- Taste disturbance
How many cases of infective endocarditis are in the US a year and what is the mortality rate

15,000 40% mortality rate
What people are at high risk to get infective endocarditis
- IV drug abuse
- Patients with prosthetic valves
- Previous HX
- Cardiac valve replacement surgery
What is the most common type of infective endocarditis

Acute via staphylococci
Which kind of IE is slow onset

Subacute
What are some clinical signs of IE
- Fever
- blood culture
- Audbile heart murmur
What is the percentage of bacteremia with manuel tb

20-68%
What is the percentage of bacteremia with use of toothpicks

20-40%
What is the percentage of bacteremia with use of oral irrigator

7-50%
What is the percentage of bacteremia with chewing food

7-51%

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Cardio disease

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Cardio disease

Updated

2010-12-13T00:17:56Z

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